Case Study: The Uninsured
TRUE STORIES OF UNNECESSARY SICKNESS, DEATH AND HUMILIATION.
The New Physician September 2000
by Howard BellVolume 49, Issue 6
One in six Americans does not have health insurance, and many live sicker and die younger because of it. The ones Dr. Debra Richter thinks of are dead—like George and his sister, Tina. Richter took care of them at an inner-city health center in Buffalo, New York. Diabetics since childhood, their disease went untreated because the family rarely had health insurance. When they were teenagers, Tina waitressed and George worked in factories. None of their employers offered them health insurance. They earned too much money to qualify for Medicaid, and they couldn’t afford to buy private insurance, so they went without insulin, syringes and glucometer sticks.
“I’d talk drug companies into giving us free bottles of insulin,” Richter says, “but you just don’t keep free samples of insulin lying around. Syringes were fairly easy to scrounge, but at 50 cents each, glucometer sticks were difficult to get.”
With blood sugar levels averaging 200, George went blind at age 20. Unable to see or work, depressed and housebound, his disability finally qualified him for Medicaid—too late. He died at age 21 of multiple organ failure due to uncontrolled diabetes.
Tina’s first and only baby lived for five months and never left the hospital. Cause of death: complications from gestational diabetes. A year later, Tina had a myocardial infarction. Despite a bypass, she died at age 25. “It was heartbreaking,” Richter says. “George and Tina had a strong work ethic. I had to face their mother at the funerals knowing if they had gotten good care for diabetes, we could have prevented all their end organ disease. George would not have gone blind. The baby would have lived. Neither would have had heart or kidney problems.”
“I see stories like these every day,” Richter says, “but the public never hears them because they’re anecdotal. The cause of death says kidney failure, but they really died from lack of insurance.”
MYTH: Most uninsured are poor, unemployed minorities.
FACT: Most uninsured Americans are employed and Caucasian. Seventy-five percent live in families where at least one person works full time. Twenty percent live in families that have two full-time workers.
MYTH: Young women are at the greatest risk for being uninsured.
FACT: Young men are at the greatest risk. Low-income women are more likely to qualify for Medicaid, which covers pregnant women and heads of single-parent families—usually women.
MYTH: Medicaid covers all poor people.
FACT: Only 41 percent of the poor are covered by Medicaid, which does not cover 26 percent of poor children, 40 percent of poor women and 50 percent of poor men.
MYTH: Poor children are more likely to be uninsured than adults.
FACT: Children are less likely to be uninsured than adults. Medicaid has less restrictive criteria for children than it does for adults. Medicaid only covers adults who are disabled, pregnant, elderly or who take care of dependent children. The federal Children’s Health Insurance Program covers children above Medicaid income eligibility limits but cuts off for those in families earning more than 200 percent of the federal poverty level.
MYTH: Most uninsured children live in families where no one works.
FACT: Seventy-five percent live in families where at least one family member works full time.
MYTH: Most uninsured children live in single-parent households.
FACT: More than half live with both their parents.
MYTH: Poor people who work and don’t get insurance through their employer can still qualify for Medicaid.
FACT: A parent working full time at minimum wage does not qualify for Medicaid in 32 states.
MYTH: People who don’t have health insurance simply don’t want to pay for it.
FACT: Seventy-five percent of uninsured adults say the main reason they are not insured is because they cannot afford the premiums. The uninsured are more than twice as likely to live in households having difficulty paying rent, food and utility bills. For most uninsured, going without insurance is not a preference, but a result of family budget choices.
MYTH: Poor people can use the emergency room if they need health care.
FACT: Many poor uninsured use hospital emergency rooms as their primary source of health care, at great expense to hospitals, which pass the costs on to other patients. Emergency rooms do not provide preventive care. They do not provide dialysis, chemotherapy, medications and other services people with serious illnesses need. Out of pride or fear of debt, many low-income sick people simply do nothing about their condition.
MYTH: People without insurance have adequate access to health care.
FACT: Numerous studies confirm that not having health insurance reduces your access to preventive, primary and specialty care. People without insurance are more likely to live sicker and die younger.
MYTH: Community hospitals and many doctors take care of everyone regardless of ability to pay.
FACT: Community hospitals and many doctors do provide some charity care; however, 15 percent of uninsured pregnant women are refused prenatal care when looking for a provider. Uninsured pregnant women are more than twice as likely not to receive the standard number of prenatal checkups before delivery. Uninsured hospital patients are 29 percent less likely to undergo coronary artery bypass surgery and 45 percent less likely to undergo a hip replacement.
MYTH: People who don’t participate in employer-sponsored insurance just don’t
want to pay the premiums.
FACT: Seventy-five percent of low-wage workers who are offered health benefits choose to participate. Most of those who don’t say they can’t afford the premiums.
MYTH: Middle-class workers were hit just hard as the working poor with declines in employer-sponsored coverage.
FACT: Employer-sponsored coverage has declined more for the working poor than
middle-class workers. From 1987 to 1996,
coverage for the lowest-paid fell from 54
percent to 42 percent. At the same time,
coverage for the highest-paid increased
from 87 percent to 90 percent.
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